FORM-2.3 REGIONAL OFFICES OF HEALTH & FAMILY WELFARE …
Transcript of FORM-2.3 REGIONAL OFFICES OF HEALTH & FAMILY WELFARE …
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FORM-2.3
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF COMMUNITY HEALTH CENTER
Name of the Regional Office: Raipur Chhattisgarh state
Report for the Month of: March 2011
1. ASSURED SERVICES
Sl. No. Services Balodabazar Sigmoa Garyaband
i Specialists medical Care services available
ii Care of routine & emergency cases of surgery Yes (routine) No Yes (routine)
iii Care of routine & emergency cases of Medicine Yes (routine) Yes (routine) Yes (routine)
iv Care of routine & emergency cases of Obstetrics Yes (routine) Yes (routine) Yes (routine)
v Care of routine & emergency cases of Sick Children Yes (routine) Yes (routine) Yes (routine)
vi 24 Hrs Delivery Services
Yes Yes Yes
vii Safe abortion services
No No No
viii New Born Care Services
Yes Yes Yes
ix Full Range of Family Planning Services
Yes (LTT) Yes (LTT) Yes (LTT)
x Other Medical care for management of nasal packing,
Snake bite, dog bite, etc. Yes Yes Yes
xi Blood Storage Unit No No No
xii Implementation of NHP activities
NRHM Yes Yes Yes
NVDDCP Yes Yes Yes
RNTCP Yes Yes Yes
NLEP Yes Yes Yes
NBCP Yes Yes Yes
HIV/AIDS Yes Yes Yes
NIDDCP Yes Yes Yes
IDSP Yes Yes Yes
xiii Non Communicable Diseases
Tobaccos control No No No
Injuries and Trauma No No No
CVD No No No
Mental Health No No No
NOHP No No No
Diabetes control No No No
Total Assured Services 12/24 10/24 11/24
% Assured Services 50% <50% <50%
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2. Other Services
Sl. No. Services Balodabazar Sigmoa Garyaband
2.1 Support Services
i Standards Treatment protocols Yes (NHP) Yes (NHP) No
ii IEC Material
A Rural Media – Wall Paintings Yes Yes Yes
Audio Cassettes No No No
B IEC - Group IEC
Lecture/seminars/Workshop - notes No No No
Exhibition Sets No No No
Pluck-cards No No No
Handouts No No No
C IEC-IPC-Leaflets/Folders
Diagnostic cards No Yes Yes
Photo Album No No No
Handbooks No No No
iii Training Material
Training Material for Level-I Staff No No No
Training Material for Level II staff No No No
Training Material for Level III staff No No No
Training Material for Level IV staff No No No
Training Material for Level V staff No No No
Training Material for TOT No No No
iv Skill Strengthening Training of staff No No No
v Diet to patients No No No
vi Sterilization room Yes No No
vii Central Sterilization storage Depot. (CSSD) No No No
viii Laundry No No No ix Storage Yes Yes Yes
i Citizen's charter Yes Yes No
ii Electricity supply Yes Yes Yes
iii Emergency Lights Yes No Yes
iv Telephone Yes Yes Yes
v Civil engineering No No No
vi Fire protection Yes No No
vii Water supply Yes Yes Yes
viii Waste disposal Yes* Yes No
ix Mortuary Yes Yes Yes
i Pathology (Clinical Laboratory) Yes
Under one roof
different
investigations done
Yes
ii Bacteriology Laboratory
Separate lab for
Malaria, RNTCP
Separate lab for
Malaria, RNTCP
iii Hematological laboratory
iv Serological Laboratory
V Biochemistry Laboratory
Vi Cardiac laboratory (ECG) No No No
Vii Ophthalmologic Laboratory Yes No No
Viii Imaging/Radiological Laboratory
Yes(Nonfunctional
)
Yes(Nonfunction
al)
Yes(Nonfunction
al)
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2.4. Activities of NHP Balodabazar Sigmoa Garyaband
I Human Control
I Diagnostic Services Yes Yes Yes
ii Treatment Yes Yes Yes
iii Disability management No No No
II Vector Control
I Interval Residual Spray Yes Yes Yes
ii Space spray No No No
iii Impregnated Bed Net Provision No No No
III Biological Control
I Maintenance of Hatcheries No No No
ii Release of Anti-larval Fishes No No No
iii Others No No No
IV Chemical Control
I Oil spray on water surface No No No
ii Others No No No
iii Others
V Others Activities
I Health Education Yes Yes Yes
ii Training Yes(periodic) Yes(periodic) Yes(periodic)
iii Conversance Yes Yes Yes
2.5 NRHM
1 Ante-natal Care Services Yes Yes Yes
I Intra-natal care services Yes Yes Yes
ii Post natal care services Yes Yes Yes
iii JSY care Services Yes Yes Yes
iv Immunization of Children Yes Yes Yes
v Full Range of FP Services Yes Yes Yes
vi Health Education Yes Yes Yes
vii Training Yes Yes Yes
Total Services provided
% services provided
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3. INFRASTRUCTURE AVAILABLE
3.1. Physical Infrastructure (1503.32 Sq Mts)
Sl. No. Services Balodabazar Sigmoa Garyaband
I Review by VH&SC
i Whether VH&SC are constituted Yes(145/148) Yes(92/123) Yes(168/171)
ii Whether the composition of the VH&SC is as the
guidelines. Yes NA
NA
iii Whether VH&SC are convening the meeting regularly Yes NA NA
iv If Ye, at what interval 2-3 month NA NA
v Whether Discussion as agenda are undertaken. NA NA NA
vi Whether the Minutes opf the meeting are prepared and
circulated to all the concerned
NA NA NA
vii Whether the feed back on the minutes is received. NA NA NA
viii Village Health day & Health camps are organized Yes Yes Yes
Ii Entrance Zone: (72 Sq. Mts)
Location & Floor Area
Registration & Records Yes Yes Yes
Pharmacy Yes Yes Yes
Drugs Storage Yes Yes Yes
Public Utility Yes Yes Yes
Circulation space No No No
Iii Ambulatory Zone (OPD) (321.4 Sq. Mts)
Causality/Emergency Yes
No No
GDMO Room Yes
Yes Yes(1)
AYUSH MO Room No No No
8 Specialists Room No No No
Treatment Room Yes Yes Yes
Refraction Room Yes Yes Yes
Nursing station No Yes Yes
Causality/Emergency Yes No No
Dress Room Yes Yes Yes
Injection Room Yes Yes Yes
Female Injection Room No No No
Public Utilities No No No
Waiting Room No No No
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Iv In-Patient Zone (313.76 Sq. Mts) Balodabazar Sigmoa
Garyaba
nd
Male Wards 18 12
Yes (5)
Female wards Yes (5)
Private Room No No No
Isolation Room No No No
Nursing station Yes Yes Yes
Patient areas No No NA
Ancillary areas No No NA
Rest Rooms No No NA
v Critical Zone (Operation Room/Labour Room)-(240 Sq. Mts)
Patient Area NA NA NA
Staff Area NA NA NA
Supply areas NA NA NA
OT/LR area NA NA NA
Public Utility NA NA NA
Circulation area NA NA NA
Vi Administration Zone ( 60 Sq. Mts)
General administration Yes Yes Yes
Establishment Yes Yes Yes
Accounts Yes Yes Yes
General Store Yes Yes Yes
Total No. I/S items Present
% of I/S items Present
3.2. Manpower available in the CHCs as per IPHS
Sl. No. Categories of staff Balodabazar Sigmoa Garyaband
Specialist Staff
I General Surgeon Yes No No
ii Physician No No No
iii O&G Yes No No
iv Pediatrics No No 2
v Anesthetist No No No
vi Public Health manager No No No
vii Eye Surgeon (1for every 5 CHC) No No No
viii Dental Surgeon No No No
Total # Staff
% staff against sanctioned
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Key Essential Staff Balodabazar Sigmoa Garyaband
ix GDMOs with at least 2 female MO) No No No
x Specialist of AYUSH No No No
xi GDMO (AYUSH ) No No No
xii Staff Nurse
4 3
2 (2Attched to
other places)
xiii PHN No No No
xiv ANM 2 No No(1)
xv Pharmacist/Compounder 1 2 1
xvi Pharmacist – AYUSH No No No
xvii Lab. Technician 1 2 1
xviii Radiographer 1 No 1
xix Ophthalmic Assistant 1 1 1
xx Dresser No 1 1
Total # Staff
% staff against sanctined
Other staff Balodabazar Sigmoa Garyaband
xxi Ward boy /Nursing orderly
1 2
4( 2 attached to
PHC
xxii Sweeper 2+1* 1 1
xxiii Chowkidar No No No
xxiv Dhobi No 1 1
xxv Mali No No No
xxvi Aya 1 1 1
xxvii Peon ` 1 5 2
xxviii OPD attendant No No No
xxix Registration Clerk No No No
xxx Statistical Assistant /Data entry operator 1 1 1
xxxi Accountant/Administrative Assistant 1 No 1
xxxii OT Technician 1 No No
Total
% staff against sanctioned
Grand Total # Staff
% staff against sanctioned
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3.3. Logistic Support
Sl. No. Logistics Balodabazar Sigmoa Garyaband
3.3.1 Logistics - Vehicle/Referral transport Model
i Bicycles/ Mopped No No No
ii Ambulances 1 1+1 1
iii Call vehicles 1(108) 1 1+1
iv Out sourced vehicles
3.3.2 Logistic Equipments No No No
i Surgical Instruments Set I No No No
ii Surgical Instruments Set II No No No
iii Surgical Instruments Set III No No No
iv Surgical Instruments Set IV No No No
v Surgical Instruments Set V No No No
vi Surgical Instruments Set VI No No No
vii IUD insertion Equipment Kit Yes Yes Yes
viii Normal Delivery Kit Yes Yes Yes
ix Equipment for Anesthetic Yes No No
x Equipment for Neonatal Resuscitation Yes No No
xi Material Kit for Blood transfusion No No No
xii Equipment for OT No No No
xiii Equipment for LR Yes No No
xiv Equipments for Radiology Yes Yes Yes
3.3.3 Logistics- Drugs
i Routine allopathic Drugs Yes Yes Yes
ii vaccines & antiserum Yes Yes Yes
iii Ayurvedic drugs No No No
iv Unani drugs No No No
v Sidha Drugs No No No
vi Homeopathic drugs No No No
vii Programme related drugs Yes Yes Yes
NRHM Yes Yes Yes
NVDDCP Yes Yes Yes
RNTCP Yes Yes Yes
NLEP Yes Yes Yes
NBCP Yes Yes Yes
HIV/AIDS No No No
NIDDCP Yes Yes Yes
IDSP Yes Yes Yes
NCD Limited Limited Limited
Total No. of Logistic Items Present
% logistic items present
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4 Funds allocation & Utilization Balodabazar Sigmoa Garyaband
I Funds allocated
ii Funds utilized
iii % funds utilized
5 CROSS-VERIFICATION/FIELD VERIFICATION
I Malaria Slides Balodabazar Sigmoa Garyaband
# +ve slides cross examined NA NA NA
# Discrepancies found Nil Nil Nil
# -ve blood slides cross-examined
# Discrepancies found Nil Nil Nil
Total Slides cross-examined
Total discrepancies found Nil Nil Nil
% discrepancies found 0% 0% 0%
ii Peripheral Laboratories
Adequacy of Infrastructure of the laboratories No No Yes
Trained Technician in-position Yes Yes Yes
Adequate testing equipments in place Yes Yes Yes
adequate chemicals in place No No No
Average no. of tests undertaken per day No Yes Yes
Is it overburdened No No No
Adequacy of records maintained Yes No No
Validity of results by cross checking No Good Average Average
Quality of slides and tests No Yes Yes
SOP/ Guidelines in place Yes No No
Test results are given on the same day. No No No
% of quality items present
6 SATISFACTION STUDIES Balodabazar Sigmoa Garyaband
I # staff assessed for Job Satisfaction (as per format) 1 1 1
ii # of patients assessed for Satisfaction (as per format) 1 1 1
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7. SUPERVISION & MONITORING
Sl. No. Particulars Balodabazar Sigmoa Garyaband
I MIS Established
Diseases are classified as per ICD-10 pattern No No No
MPR Format Developed Yes Yes Yes
QPR format developed Yes Yes Yes
Half yearly report format developed Yes Yes Yes
Annual Report Format developed Yes Yes Yes
Monitoring Indicators Identified No No No
If MIS is functional, provide a copy of the consolidated
Report of last month
All Necessary Records Registers maintained
A All records related to programme Yes Yes Yes
B HMIS Yes Yes Yes
C RNTCP Yes Yes Yes
D NLEP Yes Yes Yes
E IDSP Yes Yes Yes
F MCH report Yes Yes Yes
G IPD record Yes Yes Yes
H OPD record Yes Yes Yes
I Delivery register Yes Yes Yes
J JSY Yes Yes Yes
K Any others Yes Yes Yes
Ii Admin Monitoring Balodabazar Sigmoa Garyaband
Monthly Reports submitted Yes Yes Yes
Quarterly Reports submitted Yes Yes Yes
Half yearly Reports submitted Yes Yes Yes
Annual Reports Prepared Yes Yes Yes
Monitoring indicators developed No No No
If prepared, provide copy of Report for last year?
Iii Int. Audit
Monthly Review meeting organized Yes Yes Yes
Quarterly meeting organized No No No
Half Yearly Review meeting Organized No No No
Annual Meeting Organized No No No
National Review meeting organized No No No
If yes, provide a copy of ATR on the minutes No No No
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V Patient care (# Developed complications) Balodabazar Sigmoa Garyaband
Ante-natal cases 782(high Risk) 395(high risk) 105(high risk)
Post natal complication NA NA NA
New born/Infants NA NA NA
IOL cases under NBCP NA NA NA
TB cases NA NA NA
Leprosy cases NA Nil NA
other case 8 (lepra reaction) NA NA
If yes, provide a copy of the ATR
V Medical Audit (# Deaths reported &reviewed)
Maternal Deaths 5 4 3
Child deaths 62+32+18 34+12+08 36+17+24
Malaria deaths Nil NA NA
Tuberculosis Deaths NA NA
Others (specify) NA
If undertaken, provide a copy of the ATR
Vi Supervisory visits by State/National Prog. manager
what was checked Yes Yes Yes
what gaps were found Yes NA NA
what instructions were given Yes NA NA
what administrative directions given NA NA NA
Provide a copy of the follow up action taken NA NA NA
vii External Audit
Independent Review NA NA NA
Review by Expert Groups NA NA NA
If undertaken, provide a copy of the ATR NA NA NA
vii Whether the feed back on the minutes is received. NA NA NA
viii Village Health day & Health camps are organized NA NA NA
Total No. of Monitoring Items present
% Monitoring Items Present
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8 Performance of services Balodabazar Sigmoa Garyaband
8.1 Hospital performance
# patients reported in OPD in last one year 11871 22137
# days hospital OPD operated All working days NA NA
# Patient days in Hospitals NA NA NA
# Patients admitted in Hospital 1703 1450 337
# of Bed days No NA NA
# patients died in hospital 1 1 19
# Patients Discharged 1702 1449 318
# Live births occurred in hospital during reference period 317 390-2 361(129 referred)
# of infant deaths NA NA
# of Maternal Death Nil Nil Nil
# of abortions Nil Nil NA
8.2 Hospital Performance Indicators
Average daily Attendance in OPD in last one year 40-50 per day 50 80
Average duration stay in hospital NA NA NA
Bed Occupancy Ratio NA NA NA
Bed Turn over rate NA NA NA
Death rate NA NA NA
IMR NA NA NA
MMR NA NA NA
8.3 NHP
Prevalence rate NA 3.31/10,000 20 cases
New cases detection rate NA
Not calculated
Prop. Of Sever cases NA
Nil Nil
Prop. Of Child cases NA
Nil Nil
Prop. Of female cases NA
Prop. Of Deformity cases NA
Nil Nil
Prop. Of cases put on treatment among the new cases NA
2 2
Number of cases completed treatment among those put on treatment
NA No No
Number of Prevalent cases on record at the end of report month
NA Nil Nil
Number of resistant/relapse cases NA
Nil Nil
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FORM-2.4
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF PRIMARY HEALTH CENTERS
Name of the Regional Office: Raipur, Chhattisgarh
Report for the Month of: March 2011
Sl. No. Assured Services Under PHCs Mandhar Arjuni Damakheda Kochway
1.1 Medical Care Services
I OPD services Yes Yes Yes Yes
ii Emergency Services (24 Hrs) No No No Yes
iii Referral services Yes Yes Yes Yes
iv In-patient Services Yes Yes No No
1.2 Treatment of Specific cases
I Cataract surgeries No No No No
ii Primary management of Wounds No No No No
iii Primary management of Fractures No No No No
iv Minor Surgeries No No No No
v Primary treatment of Poisoning, snake & dog
bite, etc. No No No
No
vi Primary management of Burns No No No No
1.3 MCH & FP Services Mandhar Arjuni Damakheda Kochway
I ANC Yes Yes Yes Yes
ii INC (24x7 Hrs services) Yes Yes No No
iii PNC Yes Yes Yes Yes
iv JSY Yes Yes Yes Yes
v Immunization No No No No
vi MTP services No No No No
vii RTI/STD management No No No Yes
viii FP methods Yes Yes Yes Yes
ix New Born care No No No No
x Sick child care No No No No
1.4 Other Services
I Nutritional Services No No No No
ii School Health Services Yes Yes Yes Yes
iii Safe drinking water No No No No
iv Control of locally endemic diseases Yes Yes Yes Yes
v Surveillance & control of epidemic diseases Yes Yes Yes Yes
vi Collection of vital Statistics Yes Yes Yes Yes
vii Health Education Yes Yes Yes Yes
viii AYUSH services No No No No
ix Rehabilitation services
No No No
No
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1.5 National Health programme Mandhar Arjuni Damakheda Kochway
I NRHM Yes Yes Yes Yes
ii HIV/AIDS No No No No
iii NVBDCP Yes Yes Yes Yes
iv RNTCP Yes Yes Yes Yes
v NLEP Yes Yes Yes Yes
vi NBCP Yes No No No
vii NIIDCP No No No No
viii IDSP Yes Yes Yes Yes
iv NCD-Newer initiatives No No No No
1.6 Field Activities
Monitor activities of the SHCs Yes Yes Yes Yes
Activities of the ASHAs Yes Yes Yes Yes
MO to visit all SHC once in a month No No No No
HS/LHV to visit once a week No No No No
Total activities undertaken
% of activities against total
2 Other Services Mandhar Arjuni Damakheda Kochway
2.1 Basic Laboratory Services
I Routine -Urine, stool & blood No No No No
ii BT&CT No No No No
iii Bacteriology-RTI, Sputum No No No No
iv Blood smear for malaria parasite Yes Yes No Yes
v Rapid test for pregnancy Yes Yes Yes Yes
vi RPR test Syphilis/yaws No No No No
vii Rapid Diagnostic test for Typhoid No No No No
viii Rapid test kit for fecal contamination of
water No No No
No
2.2 Support Services
i Standards Treatment protocols No No No No
ii IEC Material Yes Yes Yes Yes
A Rural Media – Wall Paintings Yes Yes Yes Yes
Audio Cassettes No No No No
B IEC - Group IEC Na Na Na Na
Lecture/seminars/Workshop - notes No No No No
Exhibition Sets No No No No
Pluck-cards No No No No
Handouts
No No No
No
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C IEC-IPC-Leaflets/Folders Mandhar Arjuni Damakheda Kochway
Diagnostic cards No No No No
Photo Album No No No No
Handbooks No No No No
OPD slip Yes Yes Yes Yes
iii Training Material
Training Material for Level-I Staff No No No No
Training Material for Level II staff No No No No
Training Material for Level III staff No No No No
Training Material for Level IV staff No No No No
Training Material for Level V staff No No No No
Training Material for TOT No No No No
Others
iv Diet to patients No No No No
V Sterilization room No No No No
Vi Central Sterilization storage Depot. (CSSD) No No No No
Vii Laundry No No No No
Viii Storage Yes No Yes No
2.3 Amenities/Accessory Services Mandhar Arjuni Damakheda Kochway
Citizen's charter No No No No
Adequate Residential Accommodation with
all amenities No No No
No
Lecture Hall for training No No No No
Electricity with adequate back-up No Yes No No
Adequate water supply No No No No
Telephone No No No No
Garden No No No No
Waste disposal facilities No No No No
2.4. Activities of NHP Mandhar Arjuni Damakheda Kochway
I Human Control
I Diagnostic Services Yes Yes Yes Yes
ii Treatment Yes Yes Yes Yes
iii Disability management
No No No
No
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II Vector Control Mandhar Arjuni Damakheda Kochway
I Interval Residual Spray Yes Yes Yes Yes
ii Space spray No No No No
iii Impregnated Bed Net Provision No No No No
III Biological Control
I Maintenance of Hatcheries No No No No
ii Release of Anti-larval Fishes No No No No
iii Others
IV Chemical Control
I Oil spray on water surface No No No No
ii Others No No No No
iii Others
V Others Activities Mandhar Arjuni Damakheda Kochway
I Health Education Yes Yes Yes Yes
ii Training No No No No
iii Conversance
2.5 NRHM
1 Ante-natal Care Services Yes Yes Yes Yes
I Intra-natal care services Yes Yes Yes No
ii Post natal care services Yes Yes Yes Yes
iii JSY care Services Yes Yes Yes No
iv Immunization of Children At HSC At HSC At HSC At HSC
v Full Range of FP Services No No No No
vi Health Education Yes Yes Yes Yes
vii Training No No No No
Total activities undertaken
% of activities against total
16
Sl. No. Infrastructure Mandhar Arjuni Damakheda Kochway
3.1 Review by HP&HM Committee/RKS
I Whether VH&SC are constituted Yes Yes Yes Yes
Ii Whether the composition of the VH&SC is
as the guidelines. Na Na Na
Na
Iii Whether VH&SC are convening the meeting
regularly Na Na Na
Na
Iv If Ye, at what interval
V Whether Discussion as agenda are
undertaken. Na Na Na
Na
Vi Whether the Minutes opf the meeting are
prepared and circulated to all the concerned Na Na Na
Na
Vii Whether the feed back on the minutes is
received. Na Na Na
Na
Viii Village Health day & Health camps are
organized Yes Yes Yes
Yes
3.2 Physical Infrastructure Mandhar Arjuni Damakheda Kochway
I PHC Building
Easily accessible within locality Yes Yes Yes Yes
Building government or rented Govt Rented Govt Govt
Wheel chair friendly No No No No
Well Lit & Ventilated Yes No Yes Yes
Plinth Area 375 to 450 Sq. mtrs Na Na Na Na
Boundary wall/fence No No Yes No
ii Entrance
Registration and Record Room Yes No Yes Yes
Drug dispensing room Yes No Yes Yes
Waiting area for patients Yes Yes Yes Yes
Ramps at the doorways No No No No
iii Waiting area
Adequate seating No No No No
Display of HE Material Poor Poor Poor
Poor
Separate Public utility No No Yes Yes
Facility for drinking water No No No No
Proper sign boards Yes No Yes Yes
Complaint box No No No No
clean surrounding, no water logging No No Yes N
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iv Outpatient Department Mandhar Arjuni Damakheda Kochway
Separate consultation & examination room No No No No
Privacy for physical examination Yes Yes Yes Yes
Public utility Yes No Yes Yes
v In-patient Wards
4-6 beds separate wards for Male & females No No No No
Facility for drinking water No No No No
clean toilet No No No No
separate nursing duty room No No No No
Nursing station No No No No
clean linen No No No No
provisions of Diet No No No No
Cleaning of wards Fair Fair Fair Good
vi Operation Theater
change room No No No No
Separate storing sterile & other material No No No No
Adequate Equipments No No No No
Simple Surgical Procedure Yes No No No
vii Labour Room
Separate septic & aseptic deliveries No No No No
well lit & ventilated No No Yes No
Toilet No No Yes Yes
Drinking water No No No No
separate storing of dirty & clean linen No No No No
Baby care room No No No No
viii Minor OT
Minor surgeries Yes No No No
Emergencies/causality management No No No No
well equipped to handle emergencies No No No No
ix Laboratory
Sufficient space No Yes Yes Yes
Separate areas for collection & Screening No No No No
should have marble /stone tables & bash
basins No Yes No
No
x General Stores
Separate sterile & common linen, drugs etc. No No No No
well lit & ventilated No No Yes Yes
Sufficient space No No Yes Yes
dispensing cum store No No No No
Vaccine & antiserum No No No No
Grand total Infrastructure Facilities
% of physical infrastructure Facilities
18
3.3. MANPOER IN PHC
Sl. No. Action points Mandhar Arjuni Damakheda Kochway
I Medical officer (Exiting-1, Recommen -3) 02 01 00 00
AYUSH Practioner (Exiting-0,
Recommended -1) 00 00 00
01
Account Manager (Exiting-0,
Recommended -1) 00 00 00
00
ii Pharmacist (Exiting-1,
Recommended -2) 01 01 01
00
iii Nurse – Midwife/Staff Nurse (Exiting-1,
Recommended -5) 01 00 00
00
iv Health Worker (female) (Exiting-1, Recommended -1)
00 00 00 00
v Health Educator (Exiting-1,
Recommended -1) 00 00 00
00
vi Health Assistant (1 (M), 1 (F) (Exiting-2,
Recommended -2) 00 00 00
00
vii Clerks (Exiting-2,
Recommended -2) 00 00 00
00
viii Laboratory technician (Exiting-1,
Recommended -2) 01 00 00
00
ix Driver (Exiting-1,
Recommended -0) 00 00 00
00
x Class IV (Exiting-4,
Recommended -4) 01 01 00
02
TOTAL (Exiting-15,
Recommended -24/25) 06 03 01
04
RMA 1 1 1 1
3.4. LOGISTICS SUPPORT IN PHC
Sl. No. Logistics Mandhar Arjuni Damakheda Kochway
I Equipment:
Physical Examination in OPD Yes Yes Yes Yes
Ophthalmologic examination & Eye care Yes No No No
Equipment required under NHP No No No No
Set for Labour Room for Normal/assisted
delivery No No No
No
Equipment for IUD Yes Yes No No
Equipment for pap smear No No No No
Equipment for laboratory No No No No
Necessary Furniture No No No No
ii Drugs
General Drugs Yes Yes Yes Yes
Ayush drugs No No No No
Drugs for RCH programme No No No No
Drugs for RTI/STI No No No No
Ayurvedic Drugs No No No No
Unani medicines No No No No
Sidha Medicines No No No No
Homeopathy medicines No No No No
Programme related No No No No
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iii Transport Facilities
Referral facilities for emergency patients No No No No
Supervision & other out reach activities No No No No
4
FUNDS ALLOCATION &
UTILIZATION Mandhar Arjuni Damakheda
Kochway
I Funds allocated 175000 000 101000 0
ii Funds Utilized 48000 000 86000 0
iii % utilization
5
I Malaria slides Mandhar Arjuni Damakheda Kochway
# +ve slides cross examined NA NA NA NA
# discrepancies found NA NA NA NA
# -ve blood slides cross-examined NA NA NA NA
# Discrepancies found NA NA NA NA
Total Slides cross-examined NA NA NA NA
Total discrepancies found NA NA NA NA
% discrepancies found NA NA NA NA
ii Peripheral Laboratories
Adequacy of Infrastructure of the
laboratories POOR NA NA
NA
Trained Technician in-position 01 00 00 00
Adequate testing equipments in place NO NO NO NO
adequate chemicals in place NA NO NO NO
Average no. of tests undertaken per day 50 00 00 00
Is it overburdened NA NO NO NO
Adequacy of records maintained NO NO NO NO
Validity of results by cross checking NA NA NA NA
Quality of slides and tests NA NA NA NA
SOP/ Guidelines in place NA NO NO NO
Test results are given on the same day. NA NO NO NO
% of quality items present
6 SATISFACTION STUDIES
I Job Satisfaction (as per format) 2 2 2 2
ii Patient's Satisfaction (as per format) 1 1 1 1
20
7. SPERVISION & MONITORING
Sl. No. Particulars Mandhar Arjuni Damakheda Kochway
i MIS Established
Diseases are classified as ICD-10 Pattern No No No No
MPR Format Developed Yes Yes Yes Yes
QPR format developed No No No No
Half yearly report format developed No No No No
Annual Report Format developed Yes Yes Yes Yes
Monitoring Indicators Identified Yes Yes Yes Yes
If MIS is functional, provide a copy of the
consolidated Report of last month
All Necessary Records Registers maintained NA NA NA
a
b
c
d
e
f
ii Admin Monitoring
Monthly Reports submitted Yes Yes Yes Yes
Quarterly Reports submitted No No No No
Half yearly Reports submitted No No No No
Annual Reports Prepared Yes Yes Yes Yes
Monitoring indicators developed Yes Yes Yes Yes
If prepared , provide a copy of the Report for
the last year?
iii Int. Audit
Monthly Review meeting organized Yes Yes Yes Yes
Quarterly meeting organized NA NA NA NA
Half Yearly Review meeting Organized NA NA NA NA
Annual Meeting Organized Yes Yes Yes Yes
National Review meeting organized NA NA NA NA
If yes, provide a copy of ATR on the
minutes
21
iv Patient care (# Developed complications) Mandhar Arjuni Damakheda
Kochway
Ante-natal cases NA NA NA NA
Post natal complication NA NA NA NA
New born/Infants NA NA NA NA
IOL cases under NBCP NA NA NA NA
TB cases NA NA NA NA
Leprosy cases NA NA NA NA
other cases
If yes, provide a copy of the ATR
v Medical Audit (# Deaths reported
&reviewed)
Maternal Deaths NA NA NA NA
Child deaths NA NA NA NA
Malaria deaths NA NA NA NA
Tuberculosis Deaths NA NA NA NA
Others (specify) NA NA NA NA
If undertaken, provide a copy of the ATR
vi Supervisory visits by State/National Prog.
Manager
what was checked NA NA NA NA
what gaps were found NA NA NA NA
what instructions were given NA NA NA NA
what administrative directions given NA NA NA NA
Provide a copy of the follow up action taken NA NA NA NA
vii External Audit
Independent Review NA NA NA NA
Review by Expert Groups NA NA NA NA
If undertaken, provide a copy of the ATR NA NA NA NA
Total No. of Monitoring Items present
% Monitoring Items Present
22
8 Performance of services Mandhar Arjuni Damakheda Kochway
8.1 Hospital performance
# patients reported in OPD in last one year 3948 988 2663 2400
# days hospital OPD operated NA NA NA NA
# Patient days in Hospitals NA NA NA NA
# Patients admitted in Hospital 35 93 0 0
# of Bed days NA NA NA NA
# patients died in hospital NIL NIL NIL NIL
# Patients Discharged NA NA NA NA
# Live births occurred in hospital during
reference period 10 58 00
00
# of infant deaths NIL NIL NIL NIL
# of Maternal Death NIL NIL NIL NIL
# of abortions NIL NIL NIL NIL
8.2 Hospital Performance Indicators
Average daily Attendance in OPD in last one
year 15 6 10
8
Average duration stay in hospital 8HRS 8HRS 8HRS 8HRS
Bed Occupancy Ratio NA NA NA NA
Bed Turn over rate NA NA NA NA
Death rate NA NA NA NA
IMR NA NA NA NA
MMR NA NA NA NA
8.3 NHP
Prevalence rate NA NA NA NA
New cases detection rate NA NA NA NA
Prop. Of Sever cases NA NA NA NA
Prop. Of Child cases NA NA NA NA
Prop. Of female cases NA NA NA NA
Prop. Of Deformity cases NA NA NA NA
Prop. Of cases put on treatment among the
new cases NA NA NA
NA
Number of cases completed treatment among
those put on treatment NA NA NA
NA
Number of Prevalent cases on record at the
end of report month NA NA NA
NA
Number of resistant/relapse cases NA NA NA NA
23
FORM-2.5
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF SUB-HEALTH CENTERS
Name of the Regional Office: Raipur
Report for the Month of: March 2011
1. ASSURED SERVICES BY HSC:
Sl. No. Services Siltara Rawan Bishrampur Kochvay
1.1 Maternal Health
Antenatal Care Yes Yes Yes Yes
Intranasal care Yes No No Yes
Postnatal Care Yes Yes No Yes
JSY Scheme Yes Yes Yes Yes
1.2 Child Health:
Newborn Care Services Yes Yes Yes Yes
Promotion of exclusive breast feeding Yes Yes Yes Yes
Full Immunization of Children Yes Yes Yes Yes
Vitamin A prophylaxis Yes Yes Yes Yes
Assistance to school health services Yes Yes Yes Yes
Prevention & control of Childhood diseases Yes Yes Yes Yes
1.3 Family planning & Contraceptive:
IEC to ECs for adopting FP methods Yes Yes Yes Yes
Provision of contraceptives Yes Yes Yes Yes
Follow up services to Ecs adopting CCs Yes Yes Yes Yes
1.4 Counseling for safe abortion (MTP) & proper
referral Yes Yes Yes Yes
1.5 Assistance for School Health Services Yes Yes Yes Yes
1.6 Control of locally endemic diseases Yes Yes Yes Yes
1.7 Disease Surveillance & Control:
Surveillance of abnormal increase of cases Yes Yes Yes Yes
Weekly reporting of information on syndromes
surveillance Yes Yes Yes Yes
High level of alertness for unusual events & action Yes Yes Yes Yes
1.8 Water Quality Monitoring No No No No
Disinfections of water No No No No
testing of water quality No No No No
1.9 Promotion of sanitation & disposal of garbage Yes Yes Yes Yes
1.1 Curative Services
Treatment of minor ailments Yes Yes Yes Yes
Proper referral Yes Yes Yes Yes
Organizing Health days No No No No
Provide treatment as per AYUSH No No No No
24
2 Other Services Siltara Rawan Bishrampur Kochvay
2.1 Support services
i Availability of the Guidelines Yes Yes Yes Yes
ii Laboratory -Routine tests No No No No
Regular Skill development training/CME Yes Yes Yes Yes
iii IEC material Yes No No No
A Rural Media – Wall Paintings Yes No No Yes
Audio Cassettes No No No No
B IEC - Group IEC
Lecture/seminars/Workshop – notes No No No No
Exhibition Sets No No No No
Pluck-cards No No No No
Handouts No No No No
C IEC-IPC-Leaflets/Folders No No No No
Diagnostic cards No No No No
Photo Album No No No No
Handbooks No No No No
iv Training Material
Training Material for Level-I Staff No No No No
Training Material for Level II staff No No No No
Training Material for Level III staff No No No No
Training Material for Level IV staff No No No No
Training Material for Level V staff No No No No
Training Material for TOT No No No No
Others No No No No
v Waste disposal Yes No No No
2.2 Accessory Services
Availability of Regular Electricity Yes Yes Yes Yes
Availability of safe drinking Water Yes No Yes No
Telephone No No No No
Transport No No No No
Citizen's Charter Yes No No Yes
2.3 Others field activities
field visits Yes Yes Yes Yes
Community need assessment Yes Yes Yes Yes
Training No No No No
Records of vital events Yes No No Yes
2.40 National Health programme
NRHM Yes Yes Yes Yes
HIV/AIDS No No No No
NVBDCP Yes Yes Yes Yes
RNTCP Yes Yes Yes Yes
NLEP Yes Yes Yes Yes
NBCP Yes Yes Yes Yes
IDSP Yes Yes Yes Yes
NCD & Cancer Control No No No No
25
3 INFRASTRUCTURE REQUIREMENTS: Siltara Rawan Bishrampur Kochvay
3.1 Review by VH&SC
i Whether VH&SC are constituted Yes Yes Yes No
ii Whether the composition of the VH&SC is as the
guidelines. Yes Yes Yes No
iii Whether VH&SC are convening the meeting
regularly Yes No Yes No
iv If Ye, at what interval 2 – 3 months No 6 – 9 months No
v Whether Discussion as agenda are undertaken. No No No No
vi Whether the Minutes of the meeting are prepared
and circulated to all the concerned No No No No
vii Whether the feed back on the minutes is received. No Nos No No
viii Village Health day & Health camps are organized No No No No
3.2 Physical Infrastructure
I Building
SHCs located within locality Centre Centre Corner Front
Government building for SHCs Yes Yes Yes Yes
Compound wall / Fencing gate No No No No
Residential facility for HW (F)? Yes Yes Yes Yes
Separate public utilities for M&F No No No No
Plinth area (73.50 to 100.20 Mtrs) Not Known Not known Not known Not Known
Present condition of building. Good Good Good Poor
Condition of plaster on walls Good Good Good Poor
Condition of floor. Good Good Good Poor
Whether the cleanliness is maintained Yes Poor Yes Yes
ii Waiting Area
Prominent display boards in local language No No No No
Visit Schedule of ANM Yes Yes Yes Yes
Suggestion / complaints box No No No No
Display of IEC material Yes No No Yes
Seating arrangements Yes Yes Yes Yes
iii Clinical Room
Examination table Yes Yes No Yes
OPD Equipment (stethoscope, BP apparatus, Weight
Machine, etc) Yes Yes Yes Yes
Necessary furniture Yes Yes Yes Yes
iv Labour room available
Labour room available No Yes Yes No
Lithotomy table No No No No
Equipment trolly No No No No
Linen No No No No
Delivery Set Yes Yes Yes Yes
Suction apparatus Yes No No No
Newborn case set Yes Yes Yes Yes
26
v Residential Accommodation Siltara Rawan Bishrampur Kochvay
Living Room – 2 Yes Yes Yes Yes
Kitchen Yes Yes Yes Yes
W.C. Yes Yes Yes Yes
Bath Room Yes Yes Yes Yes
ANM Stays at Sub-center Yes Yes No Yes
HW(M) stays at Sub-center No No No No
3.3 Man power
ANM 1 1 1 1
Additional ANM 0 0 0 0
HW (Male) 0 0 0 0
AWW 5 6 1 3
ASHA 10 4 4 6
Volunteer Worker 0 0 0 0
3.4 LOGISTIC SUPPORT
I Equipments
OPD set Yes Yes Yes Yes
Delivery Set Yes Yes Yes Yes
IUD set Yes Yes Yes Yes
First Aid set Yes Yes Yes Yes
DDKs No No No Yes
Furniture No Yes Yes Yes
ii Drugs
Drug Kit-A (ORS, IFA, Vit.A,Co-tri) Yes Yes Yes Yes
Drug kit-B (Drugs related to delivery) No Yes Yes Yes
Additional drugs (used for sever infection) Yes No Yes Yes
Other Drugs&vaccine (UIP Vaccine) No No Yes Yes
NHP drugs (Malaria, MDT, DOT Yes Yes Yes Yes
Contraceptive supplies (Nirodh, OP, Cu.T) Yes Yes Yes Yes
AWW drug Kit No No No No
ASHA drug Kit Yes Yes Yes Yes
iii Referral Services
Provisions of referral Yes Yes Yes Yes
4 Funds allocated & Utilization
Un-Tied Funds of Rs. 10000/annum 20000 10000 20000 20000
Funds allocated & Utilization
Funds utilized 11790 8903 6758 18630
% utilization 58.98 99.03 33.79 93.15
4 Field verifications
4.1 Field Verification CC Users
Sterilization 3 2 4 3
IUD 1 3 No List 0
Oral Pill 4 0 2 1
Nirodh 1 1 0 2
4.2 Field verification of the Mothers
ANC 4 2 2 3
PNC 3 4 3 4
JSY mothers 3 3 4 4
4.3 Field Verification of the Children 3 4 3 3
27
5 Satisfaction studies Siltara Rawan Bishrampur Kochvay
5.1 Client satisfaction
Client satisfaction towards ANM Yes Yes Yes Yes
Client satisfaction towards ASHA Yes Yes Yes Yes
Satisfaction of PRI Yes Yes Yes Yes
5.2 Job Satisfaction
SHC staff Yes Yes Yes Yes
PHC staff
CHC staff
6 Record Maintenace
Sl. No. Registers Maintained Siltara Rawan Bishrampur Kochvay
I Eligible Couples Register Yes Yes Yes Yes
ii Maternal & Child Health Register Yes Yes Yes Yes
a Antenatal, Intra-natal, postnatal Yes Yes Yes Yes
b Under five Register – Immunization Yes Yes Yes Yes
c Under five Register - Growth Monitoring No No No No
iii Birth & Death Register Yes Yes Yes Yes
iv Drug Register Yes Yes Yes Yes
v Equipment/Furniture Register Yes Yes Yes Yes
vi Communicable diseases/ Epidemic Register No No Yes Yes
vii Passive surveillance register for malaria cases Yes Yes Yes Yes
viii Register for record pertaining to JSY No No No No
ix Register for maintenance of account including untied funds Yes Yes Yes N / A
x Register for water quality and sanitation No No No No
xi Minor ailments Register Yes Yes Yes Yes
xii Records/registers as per various National Health Programme guidelines Yes Yes Yes Yes
No of Register Maintained properly 11 11
11
11
% of Maintained properly 73.33 73. 33 73. 33 73. 33s
28
7 SPERVISION & MONITORING Siltara Rawan Bishrampur Kochvay
Sl. No. Particulars
i HIS Established
Diseases are classified as per ICD-10
Pattern No No No No
Monthly Progress Report Format used Yes Yes Yes Yes
MPR received from all reporting units Yes Yes Yes Yes
MPR Summarized & Reviewed Yes Yes Yes Yes
Feedback on MPR given No No No No
ii Admin Monitoring
Monthly Reports submitted Yes Yes Yes Yes
Quarterly Reports submitted No No No No
Half yearly Reports submitted No No No No
Annual Reports Prepared Yes Yes Yes Yes
iii Int. Audit
Monthly Review meeting organized Yes Yes Yes Yes
Quarterly meeting organized No No No No
Half Yearly Review meeting Organized No No No No
Annual Meeting Organized No No No No
iv Medical Audit (# Deaths/complications
reported and reviewed iro) Siltara Rawan Bishrampur Kochvay
Maternal Deaths 0 0 0 0
Child deaths 5 2 1 0
Malaria deaths 0 0 0 0
Tuberculosis Deaths 0 0 0 1
Others (specify) 18(Oldage&Exi.) 27(oldage&Exi.) 23(Oldage&Exi.)
v Supervisory visits by State/NPM
what was checked No checked No checked No checked No checked
what gaps were found
what instructions were given
what administrative directions given
what follow up action taken
vi External Audit
Independent Review
Review by Expert Groups
8 Performance Indicators
I
# ECs using CCs methods for more than 6 months continuously. 15 11 13 12
ii # ANC mothers Registered 110 101 133 34
iii # Mothers gone through the delivery 72 90 158 79
iv # mothers have hospital deliveries 22 40 25 22
v # Children upto 23 months immunized 17 19 15 21
vi # Infant deaths 0 0 0 0
vii # Maternal Deaths 0 0 0 0
viii # Malaria cases treated 138 44 35 . 74
ix # TB cases under treatment 0 0 0 0
x # Leprosy cases under treatment 1 1 0 0
xi # cases blindness & refractive errors treated 0 0 0 0
xii # HIV/AIDS cases under treatment 0 0 0 0
29